Niacin (nicotinic acid, vitamin B3) was considered a promising candidate to prevent cardiovascular disease because it is known to lower cholesterol in the blood, which is one of the main risk factors.
Hello this is dr. bradley family physician st. george utah and today i want to talk about the use of niacin and prevention of cardiovascular disease so starting out early in my career you know we were taught that niacin is one of those essential supplements or medications that become too given a patient’s who can’t tolerate statins or specifically patients who have
A low hdl to bring up their hdl which is your good cholesterol or if they have high triglycerides to address triglycerides and that it will make a difference in their overall come and data in the last few years has shown that that’s probably not the case so this is a review of a study that was published in the american county family physicians a overall summary
Of the review looking at retrospective data basically doing with a cohort study and primary looking at the cochrane database of medical studies to compile multiple studies together so that we have a larger number of patients data in the overall analysis to increase the strength of eight and actually look at and see is the recommendations that are be given strong
Recommendations and truly reflective of the data the way that they should be so the ultimate question that they asked in this particular study is is nice and effective for primary and secondary prevention of cardiovascular or cerebral vascular events so what does that mean if you never have a heart attack or stroke can we reduce your risk of heart attack and stroke
By using niacin or if you have had an event previously can we reduce your risk of having the secondary event that’s what the question is asking so this was a review that the data again as a cohort study by joseph r yancey md and defense health agency falls church virginia and jean marie bier amd fort belvoir community hospital fort belvoir virginia okay so let’s
Take a look at the data so they looked at niceand as either model therapy so nice and in and of itself or in combination with a statin so a cluster medication versus placebo in terms of overall mortality meaning risk of death cardiovascular events mean heart attack cerebral vascular events meaning stroke and adverse events of taking the medication niacin so this
Compiling together 23 different randomized control trials that were published between 1960 in 2015 resulting in just under 40,000 patient data star 39,000 195 patients that they looked at so the overall analysis of this data of the mean of the study was that niacin otherwise known as nicotinic acid or vitamin b3 does not reduce myocardial infarctions meaning heart
Attacks strokes or overall mortality when used for either primary meaning you’ve never had an event before or a second very mean you’ve had event we’re trying to prevent a future event from happening that’s pretty hard fast data so let’s look at how they came to that conclusion so again we do know over the years that nice and has been shown to be one of the most
Effective agents and increasing serum levels of hdl which is your good cholesterol and that patients with a low level of hdl in it myself our independent risk factor for having cardiovascular or cerebral vascular meaning heart attack or stroke events however by using nice and to adjust the hdl cholesterol in and of itself did not seem to change the secondary or
Primary endpoints in preventing those things from happening nice and did a parent to increase the risk of several adverse events which is really not surprising i see these all the time in my office so increased risk of flushing in seven point six nine percent of patients who take nice and the number needed to treat to a cost one a person to have flushing 3.5 so
One out of every three patients who take nice and are going to have problems with flushing per itis or itching so the numbers needed at a treat to cause harm four point eight so one out of four patients who take you’re going to have pitching a rash gastrointestinal problems increased risk of developing diabetes and nice ins or users were also more likely to quit
Using the medication in the first place just because of all the side effects what they’re having so again that’s not surprising so again the overall treatment point is if you were prescribing niacin still for your patients to try to reduce the rest of them having a heart attack or stroke please stop the data is very clear this does not help let’s focus on those
Things that are meaningful that will help and stop giving patients side-effects from using this nice than medications and hopefully make their life a little better but also help reduce their risk of harm and in the end i hope this information has been helpful for you as a patient but also as a medical provider hopefully this will help with changing some of your
Prescribing patterns if you have still been using nice and are recommending this and until next time this is dr. bradley family physician in st. george utah peraleda
Transcribed from video
Stop Using Niacin to Prevent Vascular Disease! By Dr. Karen Radley
